Urology Commons^™

Neuroendocrine Gene Subsets Are Uniquely Dysregulated In Prostate Adenocarcinoma, Nicole M. Naranjo, Anne Kennedy, Anna Testa, Cecilia E. Verrillo, Adrian D. Altieri, Rhonda Kean, D. Craig Hooper, Jindan Yu, Jonathan Zhao, Oliver Abinader, Maxwell W. Pickles, Adam Hawkins, William Kevin Kelly, Ramkrishna Mitra, Lucia R. Languino

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Prostate cancer has heterogeneous growth patterns, and its prognosis is the poorest when it progresses to a neuroendocrine phenotype. Using bioinformatic analysis, we evaluated RNA expression of neuroendocrine genes in a panel of five different cancer types: prostate adenocarcinoma, breast cancer, kidney chromophobe, kidney renal clear cell carcinoma and kidney renal papillary cell carcinoma. Our results show that specific neuroendocrine genes are significantly dysregulated in these tumors, suggesting that they play an active role in cancer progression. Among others, synaptophysin (SYP), a conventional neuroendocrine marker, is upregulated in prostate adenocarcinoma (PRAD) and breast cancer (BRCA). Our analysis shows that SYP …

Impact Of Rural Location On Receipt Of Standard Of Care Treatment And Survival For Locally Advanced Bladder Cancer In Louisiana, Megan Escott, Yong Yi, Ashley Foret, Ting Ting Li, Mei Chin Hsieh, Scott E. Delacroix, Xiao Cheng Wu, Mary E. Westerman

School of Public Health Faculty Publications

Objective: We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. Methods: Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area-Tract-level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional …

Prevalence And Relevant Factors Of Nocturia And Its Impact On Sleep Quality In Chinese University Students, Yakai Liu, Zhenwei Zhang, Huijie Hu, Xiangfei He, Pengchao Xu, Qifeng Dou, Cuiping Song, Huiqing Zhang, Israel Franco, Konstantinos Kamperis, Søren Rittig, Jianguo Wen

Faculty, Staff and Student Publications

The purpose of this study was to investigate the prevalence and relevant factors of nocturia and its impact on sleep quality in university students in Mainland China. A large-scale survey was conducted on 14,000 university students from 3 universities in Henan province, China by using an anonymous questionnaire. The questionnaire collected the information from the past six months. The relationships between the prevalence of nocturia and its relevant factors were evaluated. A total of 13,874 questionnaires were collected and 13,104 qualified for statistical analysis. A total of 659 students suffered from clinically relevant nocturia (CRN) (4.56% in male and 5.34% …

Barriers To And Facilitators Of Paediatric Medical Device Innovation: A Scoping Review Protocol, Lynn Kysh, Grzegorz Zapotoczny, Lisa Manzanete, Megan Carey, Payal Shah, Francesca Joseph, Haley Kempf, Abu Taher Sikder, Julia Finkel, Usha Thekkedath, Kara Toman, Chester J Koh, Kolaleh Eskandanian, Juan Espinoza

Faculty, Staff and Students Publications

INTRODUCTION: The development of paediatric medical devices continues to lag adult medical devices and contributes to issues of inequity, safety, quality and patient outcomes. New legislation and funding mechanisms have been introduced over the past two decades, but the gap remains. Clinical trials have been identified as a pain point, but components of effective clinical research infrastructure are poorly understood. As part of a multimodal research strategy, the Pediatric Device Consortia (PDC) will conduct a scoping review to better understand infrastructural barriers to and facilitators of paediatric medical device clinical research identified in the health sciences literature.

METHODS AND ANALYSIS: …

Access To Prostate-Specific Antigen Testing And Mortality Among Men With Prostate Cancer, Hari S. Iyer, Benjamin V. Stone, Charlotte Roscoe, Mei Chin Hsieh, Antoinette M. Stroup, Charles L. Wiggins, Fredrick R. Schumacher, Scarlett L. Gomez, Timothy R. Rebbeck, Quoc Dien Trinh

School of Public Health Faculty Publications

Importance: Prostate-specific antigen (PSA) screening for prostate cancer is controversial but may be associated with benefit for certain high-risk groups. Objectives: To evaluate associations of county-level PSA screening prevalence with prostate cancer outcomes, as well as variation by sociodemographic and clinical factors. Design, Setting, and Participants: This cohort study used data from cancer registries based in 8 US states on Hispanic, non-Hispanic Black, and non-Hispanic White men aged 40 to 99 years who received a diagnosis of prostate cancer between January 1, 2000, and December 31, 2015. Participants were followed up until death or censored after 10 years or December …

Rates Of Urinary Tract Infection In Transgender Women Postvaginoplasty Vs Cisgender Women: A Retrospective Cohort Study In A Large Us Health Network, David Gilbert, Aishwarya Gautam, Tomasz Tabernacki, Megan Mcnamara, Rachel Pope, Shubham Gupta, Kirtishri Mishra

Student Scholarship

Objective: To describe urinary tract infection (UTI) risk 3-month postvaginoplasty (VP) in transgender women (TW) compared to cis women (CW). Methods: Using TriNetX (TriNetX, Inc, Cambridge, MA), we built cohorts of 2041 TW and 48,374,745 CW. Outcomes were ≥1 instance of UTI or Cystitis, and assessed from 3-6, 3-12, 3-36 months, and 3 months-10 years post-VP. TW and CW were age-cohorted (18-39, 40-59, 60-74) and compared at each time interval. Kaplan-Meier was used to account for loss to follow-up, along with hazard ratios and log-rank tests to determine significance (P <.05). Results: For all time intervals and age ranges, TW had a significantly (P <.0001-P = .0088) higher probability of developing a UTI compared to CW. The largest difference was ages 40-59 ten-year post-VP. In this analysis, CW and TW had a 12.96% and 29.34% cumulative outcome incidence, respectively. Cox proportional hazard analysis demonstrated increased hazard for TW compared to CW. Hazard ratios between CW and TW ranged from 1.363 (ages 18-39 at 10 years, 95%CI: 1.119,1.660) to 3.522 (ages 60-74 at 12 months, 95%CI: 1.951,6.360). Conclusion: We found a significantly higher probability of TW developing UTIs compared to age-cohorted CW. Contributing factors may include difficulties with neovaginal perineal hygiene, lack of commensal bacteria and vaginal mucosa, larger urethral meatus, high rates of meatal stenosis, and nonnative bacteria introduced through dilators and douching. These findings may help improve quality of postoperative care in TW.

Practical Guidance On Establishing A Molecular Testing Pathway For Alterations In Homologous Recombination Repair Genes In Clinical Practice For Patients With Metastatic Prostate Cancer, Martin Schostak, Angela Bradbury, Alberto Briganti, David Gonzalez, Leonard Gomella, Joaquin Mateo, Frédérique Penault-Llorca, Albrecht Stenzinger, Alexander Wyatt, Anders Bjartell

Department of Urology Faculty Papers

CONTEXT: Prostate cancer is a molecularly heterogeneous disease that is amenable to diagnostic testing to identify patients potentially eligible for personalised treatments inform familial risk and provide relevant information about potential prognosis. Several guidelines support the integration of genomic testing in a shared decision-making framework so that both health care professionals (HCPs) and patients are involved in determining the best treatment approach.

OBJECTIVE: To review current guidelines on molecular diagnostic testing for homologous recombination repair (HRR) gene alterations in patients with metastatic prostate cancer, with the aim of providing practical considerations for effective guideline implementation and establishment of an appropriate …

Specific Gravity Improves Identification Of Clinically Significant Quantitative Proteinuria From The Dipstick Urinalysis, Meredith C Mcadams, L Parker Gregg, Pin Xu, Song Zhang, Michael Li, Ella Carroll, Vaishnavi Kannan, Duwayne L Willett, S Susan Hedayati

Faculty, Staff and Students Publications

KEY POINTS: Urine albumin-to-creatinine ratio and urine protein-to-creatinine ratio are frequently obtained and represent possible tools for screening for proteinuria and thus early CKD. Adding specific gravity to dipstick proteinuria improves the ability to screen patients with clinically significant proteinuria and can be used to identify patients with early CKD.

BACKGROUND: CKD is often underdiagnosed during early stages when GFR is preserved because of underutilization of testing for quantitative urine albumin-to-creatinine ratio (UACR) or urine protein-to-creatinine ratio (UPCR). Semiquantitative dipstick proteinuria (DSP) on urinalysis is widely obtained but not accurate for identifying clinically significant proteinuria.

METHODS: We identified all patients …

Loss Of Lpar6 And Cab39l Dysregulates The Basal-To-Luminal Urothelial Differentiation Program, Contributing To Bladder Carcinogenesis, Sangkyou Lee, Jolanta Bondaruk, Yishan Wang, Huiqin Chen, June Goo Lee, Tadeusz Majewski, Rachel D Mullen, David Cogdell, Jiansong Chen, Ziqiao Wang, Hui Yao, Pawel Kus, Joon Jeong, Ilkyun Lee, Woonyoung Choi, Neema Navai, Charles Guo, Colin Dinney, Keith Baggerly, Cathy Mendelsohn, David Mcconkey, Richard R Behringer, Marek Kimmel, Peng Wei, Bogdan Czerniak

Faculty, Staff and Student Publications

We describe a strategy that combines histologic and molecular mapping that permits interrogation of the chronology of changes associated with cancer development on a whole-organ scale. Using this approach, we present the sequence of alterations around RB1 in the development of bladder cancer. We show that RB1 is not involved in initial expansion of the preneoplastic clone. Instead, we found a set of contiguous genes that we term "forerunner" genes whose silencing is associated with the development of plaque-like field effects initiating carcinogenesis. Specifically, we identified five candidate forerunner genes (ITM2B, LPAR6, MLNR, CAB39L, and ARL11) mapping near RB1. Two …

Legal Outcomes Of Litigation After Iatrogenic Genitourinary Trauma, Helen H. Sun, Crystal An, Andrew Drozd, Nicholas Sellke, Kimberly Tay, Kirtishri Mishra, Kyle Scarberry, Shubham Gupta, Nannan Thirumavalavan

Researchers, Instructors, & Staff Scholarship

Objective: To evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary (GU) trauma litigation and outcomes of closed claims. Methods: LexisNexis was queried in April 2023 using terms related to GU organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome. Results: Four hundred ten cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted …

Risks Of Depression, Anxiety, And Suicide In Partners Of Men With Prostate Cancer: A National Cohort Study, Casey Crump, Pär Stattin, James D Brooks, Jan Sundquist, Alexis C Edwards, Kristina Sundquist, Weiva Sieh

Faculty, Staff and Student Publications

BACKGROUND: A diagnosis of prostate cancer (PC) may cause psychosocial distress not only in a man but also in his intimate partner. However, long-term risks of depression, anxiety, or suicide in partners of men with PC are largely unknown.

METHODS: A national cohort study was conducted of 121 530 partners of men diagnosed with PC during 1998-2017 and 1 093 304 population-based controls in Sweden. Major depression, anxiety disorder, and suicide death were ascertained through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors.

RESULTS: Partners of men with high-risk PC had increased risks …

Efficacy Of Intravesical Nadofaragene Firadenovec For Patients With Bacillus Calmette-Guérin-Unresponsive Nonmuscle-Invasive Bladder Cancer: 5-Year Follow-Up From A Phase 3 Trial, Vikram M. Narayan, Stephen A. Boorjian, Mehrdad Alemozaffar, Badrinath R. Konety, Neal D. Shore, Leonard G. Gomella, Ashish M. Kamat, Trinity J. Bivalacqua, Jeffrey S. Montgomery, Seth P. Lerner, Joseph E. Busby, Michael Poch, Paul L. Crispen, Gary D. Steinberg, Anne K. Schuckman, Tracy M. Downs, Joseph Mashni, Brian R. Lane, Thomas J. Guzzo, Gennady Bratslavsky, Lawrence I. Karsh, Michael E. Woods, Gordon Brown, Daniel Canter, Adam Luchey, Yair Lotan, Brant A. Inman, Michael B. Williams, Michael S. Cookson, Sam S. Chang, Alexander I. Sankin, Michael A. O'Donnell, David Sawutz, Richard Philipson, Nigel R. Parker, Seppo Yla-Herttuala, Dorte Rehm, Jørn S. Jakobsen, Kristian Juul, Colin P.N. Dinney

Department of Urology Faculty Papers

Purpose: Nadofaragene firadenovec-vncg is a nonreplicating adenoviral vector–based gene therapy for bacillus Calmette-Guérin (BCG)–unresponsive carcinoma in situ (CIS) with/without high-grade Ta/T1. We report outcomes following 5 years of planned follow-up.

Materials and Methods: This open-label phase 3 trial (NCT02773849) enrolled patients with BCG-unresponsive nonmuscle-invasive bladder cancer in 2 cohorts: CIS ± Ta/T1 (CIS; n = 107) and Ta/T1 without CIS (Ta/T1 cohort; n = 50). Patients received 75 mL (3 × 1011 vp/mL) nadofaragene firadenovec intravesically once every 3 months with cystoscopy and cytology assessments, with continued treatment offered to those remaining high grade recurrence–free (HGRF).

Results: One hundred fifty-seven …

Development, Validation, And Diagnostic Performance Of A Novel Radiomic Model For Predicting Prostate Cancer Recurrence, Linda M. Huynh

Theses & Dissertations

Multi-parametric magnetic resonance imaging (MP-MRI)-derived radiomics have been shown to capture sub-visual patterns for the quantitative characterization of prostate cancer (PC) phenotypes. The present dissertation seeks to develop, evaluate, and compare the performance of an MRI-derived radiomic model for the prediction of PC recurrence following definitive treatment with radical prostatectomy (RP).

MP-MRI was obtained from 339 patients who had a minimum of 2 years follow-up following RP at three institutions. The prostate was manually delineated as the region of interest and 924 radiomic features were extracted. All features were evaluated for stability via intraclass correlation coefficient (ICC) and image normalization …

Addressing The Rates Of Contaminated Blood Cultures In The Tjuh Ed, Marina Gonzalez, Md, Trishya Srinivasan, Md, Bertilia Tavárez, Md, Natasa Kostic, Md, Virginia Gonzalez, Md, Kathleen Quinn, Bsn Rn-Bc, Michael Dong, Md

Health Equity and Quality Improvement (HEQI) Summit

Background & Aim

Blood culture contamination is a common, yet underrecognized, adverse event within emergency departments (ED). Through root cause analysis, this project identified barriers to using standardized blood culture collection techniques in the TJUH (Thomas Jefferson University Hospital) ED.

After incorporating our proposed interventions, we aim to reduce the percentage of contaminated blood cultures to

Interprofessional Pilot Approach To Standardizing Nursing-Provider Driven Postpartum Urinary Retention Protocol, Mymy Nguyen, Mary Van Schaick, Md, Charlette E. Williams, Md, Anne Bocage, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Postpartum urinary retention is a frequent cause of distress to new mothers, affecting 1 in 500 patients¹. It is imperative that patients receive prompt diagnosis and management to avoid long term sequelae of urogenital tract morbidity, including detrusor damage and bladder rupture². Although hospital protocols for urinary retention in the non-obstetric setting exist, management of urinary retention in the postpartum setting often varies by nursing-provider preference.

Project AIM: In this QI project, we developed a standardized protocol for postpartum urinary retention, and a comprehensive training model for provider and nursing teams. We assessed …

Amniotic Bladder Therapy For Treating Interstitial Cystitis/Bladder Pain Syndrome: A 6 Month Follow Up, Jack Considine, Codrut Radoiu, Sophie Wittenberg, Nivedita Dhar, Raghav Madan, Jack Vercnocke, Aron Liaw, Alaa Hamada

Conference Presentation Abstracts

Introduction: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a debilitating condition marked by chronic pelvic pain and concurrent lower urinary tract symptoms. Our prior research established the efficacy of Amniotic Bladder Therapy (ABT) in offering symptomatic relief to refractory IC/BPS patients for a duration of up to 3 months. This study aims to delve into the durability of ABT, examining its effects over a more extended period, specifically up to 6 months. Materials and Methods: Consecutive IC/BPS patients participated in the study, receiving intra-detrusor injections of 100mg micronized amniotic membrane. Comprehensive clinical evaluations were complemented by patient reported outcome measures, encompassing …

Clinical Considerations And Outcomes Of Robotic Urologic Surgery In Obese Patients, Nazih Khater, Anna G. Morris, Delena M. Vanvalkenburg, Andrew J. Garcia, Kevin Jin, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Alan David Kaye

School of Medicine Faculty Publications

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need …

Demographics And Pain: An Observational Study Of Men Attending An Urban Health Event, Steven A. Kessler, Michael D. Lutz

Posters

• Chronic pain has been estimated to be present in 11.4 to 24 percent of the population.
• Of the 369 measured diseases, the World Health Organization’s Global Burden of Disease Study has 3 conditions associated with chronic pain in the top.
• The economic burden associated with chronic pain is high, with one study suggesting higher annual costs than heart disease, cancer, and diabetes.
• Studies have shown that race and socioeconomic status are factors associated with higher prevalence of chronic pain.

• Higher in minority populations, and those of lower socioeconomic status.
• One study showed that after correcting for income, employment and adverse …

Nocturia In Men And Associated Comorbidities; A Southeast Michigan Study, Daniel Fortney, Alexander Geisenhoff, Bernadette Zwaans, Michael Lutz

Posters

• Nocturia, defined as waking up during the night to void, is a prevalent condition affecting a considerable proportion of the population.
• Many studies have demonstrated that nocturia is associated with poor quality of life and numerous adverse health outcomes 1,2,3,4.
• Patients with nocturia are estimated to have 60% greater hospitalization rates and 19% higher rates of outpatient visits, equating to an annual economic cost of $3,491 per patient 5.
• Although pre-existing studies have not consistently aligned on the association between nocturia and specific comorbidities, the overall agreement on the negative health outcomes and economic strain caused by untreated nocturia remains …

Voiding Phase Dysfunction In Multiple Sclerosis: Contemporary Review Of Terminology, Diagnosis, Management, And Future Directions, Catherine Frances Ingram, John A Lincoln, Rose Khavari

Faculty, Staff and Student Publications

Lower urinary tract symptoms (LUTS) are highly prevalent in individuals with multiple sclerosis (MS). However, assessment of these symptoms is often hindered by vague definitions or absence of screening in asymptomatic patients. It is crucial to exercise caution when applying the non-neurogenic definition of urinary retention in this population. For men with MS experiencing persistent and treatment-resistant LUTS, urodynamic studies should be used to identify the underlying causes of symptoms. Although numerous therapies are presently accessible for managing LUTS in MS, there is a need for further investigation into emerging treatments such as percutaneous tibial nerve, and noninvasive brain stimulation.